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Connecticut rates for HCPCS 64495

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $3,890.45 / $7,079.46
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$891.25 / $1,202.26 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $87.10 / $263.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$32.36 / $302.00 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,238.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $102.33 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$93.33 / $151.36 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $134.90 / $234.42
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $154.88 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,467.37 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $100.00 / $218.78